Lung Cancer Less Likely in Smokers Who Drink Red Wine

Action Points

Explain to interested patients that men in this large cohort who drank moderate amounts of red wine had a decreased risk of lung cancer, even though they had smoked.

Note that there was no association between lung cancer risk and consumption of beer, white wine, or liquor.

PASADENA, Calif., Oct. 8 -- Drinking moderate amounts of red wine may offer some protection against lung cancer in men with a history of smoking, according to a prospective cohort study.

Drinking at least one glass of wine per day was associated with a 60% decreased risk of lung cancer in those who ever smoked (HR 0.39, 95% CI 0.14 to 1.08, P=0.03), Chun Chao, Ph.D., of Kaiser Permanente Southern California, and colleagues, reported in the October issue of Cancer Epidemiology Biomarkers & Prevention.

The association was even stronger for those who had smoked more than 20 pack-years, the researchers said.

"This finding, if confirmed, is of interest for lung cancer chemoprevention in current and former smokers," they wrote.

There was no association, however, between lung cancer risk and consumption of beer, white wine, or liquor.

Previous studies have shown alcohol consumption to be associated with an increased risk of cancer, especially of the head and neck, esophagus, liver, colon, rectum, and breast. Generation of acetaldehyde and oxidative stress during the metabolism of ethanol, as well as carcinogenic contaminants like nitrosamines and polycyclic aromatic hydrocarbons, are thought to be the mechanisms by which alcohol increases the risk of these cancers.

The effect of alcohol consumption on lung cancer, however, has been uncertain.

So the researchers looked at data on 84,170 men, ages 45 to 69, in the California Men's Health Study, and identified 210 cases of lung cancer.

In a multivariate analysis that included smoking history, socioeconomic status, BMI, and history of COPD or emphysema, the researchers found no association between the risk of lung cancer and beer (HR 0.78, 95% CI 0.45 to 1.35), white wine (HR 0.87, 95% CI 0.31 to 2.40), and liquor (HR 0.93, 95% CI 0.54 to 1.58).

But there was an inverse association for red wine intake (HR 0.55, 95% CI 0.23 to 1.29), the researchers said.

Among men who had smoked at least 100 cigarettes in their lifetime, drinking at least one glass of red wine per day was associated with a 60% reduced risk of lung cancer, and a one-drink increase in red wine per month was associated with a 2% reduction in lung cancer risk (HR 0.98, 95% CI 0.96 to 1.00).

The association was even stronger for men who had smoked at least 20 pack-years in their lifetime, and the one-drink increase of red wine per month for this group was 0.96 (95% CI 0.93 to 1.00, P=0.04).

Researchers said that red wine contains high levels of antioxidants such as flavonoids and resveratrol, which may be the mechanism by which the drink protects against lung cancer.

In previous studies, resveratrol was found to alter the activation of procarcinogens in human bronchial epithelial cells in vitro, induce apoptosis in human lung cancer cell lines, and retard lung tumor growth in mice, the researchers said.

"Clinical studies will be needed to determine the effect of resveratrol from food source in humans," they wrote.

The study was limited by a lack of long-term data on alcohol use and the inability to assess the effect of heavy alcohol intake on lung cancer risk since cohort members, on average, reported moderate alcohol consumption.

In addition, they pointed out that "we had few subjects with lung cancer who were never-smokers or had squamous-cell histology, thus preventing the investigation of the effect of alcoholic beverage use in these subgroups."

Despite these limitations, the authors said, the findings suggest "further research into the lung cancer chemopreventive agents that occur in abundance in red wine."

The authors reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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